Multi-cancer Early Detection Tests, Primary Care, and Shared Decision Making
Authors: Kevin Selby, Glyn Elwyn, Robert J. Volk
Journal: Annals of Internal Medicine (2023)

Ideas and OpinionsMay 2023Multi-cancer Early Detection Tests, Primary Care, and Shared Decision MakingKevin Selby, MD, MAS, Glyn Elwyn, MD, PhD, MSc, and Robert J. Volk, PhDKevin Selby, MD, MASCenter for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland (K.S.), Glyn Elwyn, MD, PhD, MScThe Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire (G.E.), and Robert J. Volk, PhDDepartment of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (R.J.V.).Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-0067 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail "What to do you think, doc, should I get one of these tests?" I am seeing Mr. Y, a 55-year-old business school teacher with a penchant for new technologies. He is in good health, has not smoked for 20 years, and takes 1 medication for benign prostatic hypertrophy.Mr. Y shows a direct-to-consumer advertisement for a multi-cancer early detection, or MCED, test. "What if you found cancer early enough to make a difference? Seventy-one percent of cancer deaths are caused by cancers not commonly screened for" (1). The logic is compelling: Despite recommended screening, Mr. Y might benefit from additional ...References1. Grail LLC. Galleri. Accessed at www.galleri.com/ on 17 November 2022. Google Scholar2. Politi MC, Lewis CL, Frosch DL. Supporting shared decisions when clinical evidence is low. Med Care Res Rev. 2013;70:113s-128s. [PMID: 23124616] doi:10.1177/1077558712458456 CrossrefMedlineGoogle Scholar3. Elwyn G, Durand MA, Song J, et al.. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359:j4891. [PMID: 29109079] doi:10.1136/bmj.j4891 CrossrefMedlineGoogle Scholar4. Prevent Cancer Foundation. Coverage and Legislation. Accessed at www.preventcancer.org/multi-cancer-early-detection/coverage-and-legislation/ on 17 November 2022. Google Scholar5. Deverka PA, Douglas MP, Phillips KA. Multicancer screening tests: anticipating and addressing considerations for payer coverage and patient access. Health Aff (Millwood). 2022;41:383-389. [PMID: 35254936] doi:10.1377/hlthaff.2021.01316 CrossrefMedlineGoogle Scholar6. GRAIL Announces Final Results From the PATHFINDER Multi-Cancer Early Detection Screening Study at ESMO Congress 2022. Accessed at https://grail.com/press-releases/grail-announces-final-results-from-the-pathfinder-multi-cancer-early-detection-screening-study-at-esmo-congress-2022/ on 20 March 2023. Google Scholar7. Cohen JD, Li L, Wang Y, et al.. Detection and localization of surgically resectable cancers with a multi-analyte blood test. Science. 2018;359:926-930. [PMID: 29348365] doi:10.1126/science.aar3247 CrossrefMedlineGoogle Scholar8. U.S. Preventive Services Task Force . Screening for pancreatic cancer: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2019;322:438-444. [PMID: 31386141] doi:10.1001/jama.2019.10232 CrossrefMedlineGoogle Scholar9. Klein EA, Richards D, Cohn A, et al.. Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. Ann Oncol. 2021;32:1167-1177. [PMID: 34176681] doi:10.1016/j.annonc.2021.05.806 CrossrefMedlineGoogle Scholar10. Stacey D, Volk RJ; IPDAS Evidence Update Leads (Hilary Bekker, Karina Dahl Steffensen, Tammy C. Hoffmann, Kirsten McCaffery, Rachel Thompson, Richard Thomson, Lyndal Trevena, Trudy van der Weijden, and Holly Witteman). The International Patient Decision Aid Standards (IPDAS) Collaboration: Evidence update 2.0. Med Decis Making. 2021;41:729-733. [PMID: 34416841] doi:10.1177/0272989X211035681 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Kevin Selby, MD, MAS; Glyn Elwyn, MD, PhD, MSc; Robert J. Volk, PhDAffiliations: Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland (K.S.)The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire (G.E.)Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (R.J.V.).Acknowledgment: The authors thank Marie-Anne Durand and Samuel Edwards for their feedback on the manuscript.Funding Support: Dr. Selby receives salary support from the Leenaards Foundation. Dr. Volk is supported by a grant funded from National Institutes of Health, National Cancer Institute, USA, under award number P30CA016672, using the Decision Science Core.Disclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-0067.Corresponding Author: Kevin Selby, MD, MAS, Center for Primary Care and Public Health (Unisanté), Ambulatory Care Department, Rue de Bugnon 44, 1012 Lausanne, Switzerland; e-mail, kevin.[email protected]ch.Author Contributions: Conception and design: K. Selby, R.J. Volk.Drafting of the article: G. Elwyn, K. Selby, R.J. Volk.Critical revision for important intellectual content: G. Elwyn, K. Selby, R.J. Volk.Final approval of the article: G. Elwyn, K. Selby, R.J. Volk.This article was published at Annals.org on 11 April 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Current IssueMay 2023Volume 176, Issue 5Page: 718-720KeywordsCancer detection and diagnosisCancer screeningGenetic screensGenetic testingHealth careHematologic testsMortalityOverdiagnosisPrevention, policy, and public health ePublished: 11 April 2023 Issue Published: May 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...